Scandinavian journal of thoracic and cardiovascular surgery
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Scand J Thorac Cardiovasc Surg · Jan 1996
Case ReportsUnilateral Fontan operation for tricuspid atresia.
A 12-year-old child with tricuspid atresia and acquired hypoplasia of the left pulmonary artery was successfully treated with unilateral Fontan operation. Angiography at age 2 months had shown a normal left pulmonary artery, and a modified Potts shunt was performed. An emergency central shunt was required a year later. Reinvestigation 5 years after the initial operation revealed severe hypoplasia of the left pulmonary artery.
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In minitracheotomy, a relatively simple percutaneous technique for tracheal cannulation, a small-bore tube is inserted via the cricothyroid membrane to provide access to suction removal of excess secretion or aspirated material from the tracheobronchial tree. It allows efficient tracheobronchial toilet while preserving glottic function and avoiding the disadvantages of conventional tracheostomy and endotracheal intubation. The indications for minitracheotomy in 20 cases were excessive postoperative or postpneumonic secretion (14), difficulty with endotracheal suction (5) and acute airway obstruction (1). ⋯ The cannula was retained for 3-8 days and removal was followed by closure within 48 hours. There were no adverse laryngeal effects. Minitracheotomy was well tolerated by the patients and is a useful adjunct for removal of airway secretion and hospitalized patients.
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Scand J Thorac Cardiovasc Surg · Jan 1996
Endothelin in bronchoalveolar lavage fluid is increased in lung-transplanted patients.
Animal studies have shown increased endothelin in bronchoalveolar lavage (BAL) fluid during unmodified rejection. We performed radioimmunoassay of endothelin in 59 BAL fluid samples from ten patients at different times after lung transplantation. All patients received immunosuppressive therapy (cyclosporin, azathioprine and methylprednisolone). ⋯ The endothelin content of BAL (pg/ml) was significantly greater in the rejection group than in the infection group (61.1 +/- 3.8 vs 40.6 +/- 2.0) or in the 35 samples taken in uncomplicated course after lung transplantation (40.9 +/- 5.4), p < 0.01. The endothelin level in BAL fluid from the controls was only 3.0 +/- 1.4 pg/ml, significantly less (p < 0.005) than in all the lung-transplanted groups. Endothelin in BAL fluid thus was increased after lung transplantation, and still further during rejection.